Breast 'Awareness' Trumps Self-Exams, Docs Say

CNN News Wire | 11/18/2009, 5:09 p.m.
A vacation to Washington nearly a decade ago led to a life-changing revelation for Kathi Cordsen. Passing by a breast ...

Cordsen, however, thinks it's "crazy" to tell women not to examine their breasts.

But the cancer groups clarify that they're not saying "don't check your breasts"; they're just not for teaching a formal process anymore and want you to be aware of any changes.

When the Komen group turned its focus away from the self-exam process, some women who had found their own breast cancers did complain. But when Brown spoke to some of these women individually, she realized that they had largely detected lumps by coincidence -- they happened to notice a change in their bodies -- rather than during a formal self-exam at a scheduled time of the month.

At M.D. Anderson Cancer Center in Texas, doctors do not recommend that women formally examine their own breasts either. They preach "breast awareness" instead, said Dr. Therese Bevers, medical director of the center's Cancer Prevention Center.

"We were overcomplicating this, and it actually was a turnoff for a lot of women," she said. "Women go, 'I don't know how to do it, so I don't do it.' "

Generally, women should be aware of their bodies and should notice something like a lump on their breasts to the same extent that they would on their arms.

Awareness is also the main message for Dr. Anne Wallace, professor of surgery and director of the Moores Breast Cancer Program at the University of California-San Diego. Knowing your health history, when you've had sex and what's new to your body are important, she said.

Still, there are patients who would benefit from self-exams if they did them. Wallace has seen patients with large dents in their breasts and tangible masses within. When she asks them whether they had noticed anything there, they say, "Oh, gosh. I can't touch my breast. I don't know if it's new," she said.

The emotional weight attached to self-exams is so great for some women that Wallace advocates putting associated public health money toward mammograms, rather than trying to get women to be more comfortable with examining their own breasts.

"If you're used to feeling your breasts and know your lumps and bumps, then keep doing it, but if they scare you or whatnot, don't make it happen," she said. "I think we should have, years ago, lightened up on it."

Wallace estimates that 50 percent of women routinely feel their breasts for lumps.

Dr. Lori Goldstein, director of the Breast Evaluation Center at Fox Chase Cancer Center in Philadelphia, Pennsylvania, also cited the China study that showed no benefit in self-examination but said it's "value-added and complementary to mammography screening."

What else helps and hurts

Part of breast cancer risk has to do with genetics, and particularly strong links have been found to the genes BRCA1 and BRCA2. You should be aware of your own risk by taking into account your family history.

There are, however, actions that women can take to help prevent breast cancer besides having mammograms, having clinical exams and being aware of changes in their breasts.

Maintaining a healthy weight as an adult, especially after menopause, is important in decreasing risk, Brown said. Physical activity has also been shown to decrease risk in women generally, she said.

Limiting alcohol intake is another healthy lifestyle choice linked to decreased breast cancer risk, she said. There's a 20 percent greater risk of breast cancer associated with women who consume two to three alcoholic beverages per day compared with non-drinkers.